P03.06 Boolean logic puzzles as a neurosurgical mapping tool to preserve programming skill

Abstract BACKGROUND In glioma surgery, awake craniotomy with Direct Electrical Stimulation (DES) is increasingly becoming the gold standard treatment to preserve language, cognition and motor function and to optimize extent of resection. Computer programming is historically seen as an integration of cognition, language, and mathematics but an intraoperative task to monitor computer programming does not exist yet. In this study we describe a new task for intraoperative monitoring, using visual Boolean Logic Puzzles. MATERIAL AND METHODS We describe a computer programmer who underwent awake craniotomy to resect an anaplastic astrocytoma in the left superior frontal gyrus. At the request of the patient we tested programming language. We developed a new task and set of logic puzzle visual stimuli to monitor underlying cognitive function used for programming language. This test was used during preoperative functional MRI (fMRI), direct electrical stimulation (DES) and ongoing monitoring during resection. RESULTS In fMRI this task showed bilateral activation in Brodmann area 6 and 8 and for left hemisphere in Brodmann area 10. These areas are below and lateral of the tumor. Monitoring of language, motor skills and Boolean mapping was performed during DES and while resection was performed. No deficits in programming ability could be identified intra- and postoperatively. CONCLUSION Boolean Logic Puzzles may be a useful intraoperative task to preserve programming skills.

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Intraoperative electrical stimulation in awake craniotomy: methodological aspects of current practice

Neurosurgical FOCUS ◽

10.3171/2009.12.focus09237 ◽

2010 ◽

Vol 28 (2) ◽

pp. E7 ◽

Cited By ~ 186

Author(s):

Andrea Szelényi ◽

Lorenzo Bello ◽

Hugues Duffau ◽

Enrica Fava ◽

Guenther C. Feigl ◽

...

Keyword(s):

Electrical Stimulation ◽

Cognitive Function ◽

Low Grade Glioma ◽

Awake Craniotomy ◽

Awake Surgery ◽

Low Grade ◽

Glioma Surgery ◽

Neurological Sequelae ◽

Intraoperative Electrical Stimulation ◽

Methodological Aspects

There is increasing evidence that the extent of tumor removal in low-grade glioma surgery is related to patient survival time. Thus, the goal of resecting the largest amount of tumor possible without leading to permanent neurological sequelae is a challenge for the neurosurgeon. Electrical stimulation of the brain to detect cortical and axonal areas involved in motor, language, and cognitive function and located within the tumor or along its boundaries has become an essential tool in combination with awake craniotomy. Based on a literature review, discussions within the European Low-Grade Glioma Group, and illustrative clinical experience, the authors of this paper provide an overview for neurosurgeons, neurophysiologists, linguists, and anesthesiologists as well as those new to the field about the stimulation techniques currently being used for mapping sensorimotor, language, and cognitive function in awake surgery for low-grade glioma. The paper is intended to help the understanding of these techniques and facilitate a comparison of results between users.

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Language Localization in Multilingual Patients—Evidence From Direct Electrical Stimulation: A Systematic Review and Single Institution Case Series

Neurosurgery ◽

10.1093/neuros/nyz310_509 ◽

2019 ◽

Vol 66 (Supplement_1) ◽

Author(s):

Colin Teo Kok Ann ◽

Djaina Satoer ◽

Hui Minn Chan ◽

Marco Rossi ◽

Tseng Tsai Yeo ◽

...

Keyword(s):

Electrical Stimulation ◽

Standardized Test ◽

Case Series ◽

Awake Craniotomy ◽

Direct Electrical Stimulation ◽

Language Function ◽

Language Mapping ◽

Second Languages ◽

First Languages ◽

L1 And L2

Abstract INTRODUCTION To enable the safe mapping of language function in multilinguals, we need to understand how language organization in multilinguals differ from well-described organizations in monolingual patients. The development and appropriate administration of standardized test batteries intraoperatively is important to ensure accuracy of mapping, as interlanguage differences cannot be accounted by accurate translations alone. Individual or linguistic factors affects language organization. This study aims to review the published literature on language organization in multilinguals and illustrate intraoperative findings from a case series of multilingual patients who underwent language mapping during awake craniotomy at an Asian institution. METHODS This PRISMA guided review included studies on multilingual patients undergoing awake craniotomy utilizing direct electrical stimulation (DES) to localize language sites during awake craniotomy. Similar details from case series of multilingual individuals with more than one language mapped at our center, and strategies used to develop intraoperative tasks for non-English languages are also presented. RESULTS A total of 142 patients in 21 studies were included. These studies included 80.9% bilinguals, 10.5% trilinguals, 6.3% tetralinguals, 2.8% pentalinguals. Most common first languages (L1) are French (26.7%), English (16.9%), Spanish (14.0%), second languages (L2) are English (38%), Spanish (19.7%), Mandarin (7.7%). Our study noted large variation in fluency definition and evaluation methods for language and cognitive evaluation. Stimulation protocols, error definitions were similar. Naming and counting tasks most commonly used. Majority of studies (76.1%) found distinct cortical sites for L1 and L2, and shared sites as well (66.7%). There was no clear relationship between pattern of distribution and age of acquisition, proficiency or nature of language. Sites for specific tasks such as voluntary and involuntary switching, translation, and reading were identified. CONCLUSION There are distinct differences language organization between multilinguals and monolinguals. It is crucial for understanding of these differences for maximal preservation of each mapped language function to achieve maximal quality of life.

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